Rural primary care physicians are committed to professionalism, quality improvement

February 20, 2014

The increased demand for primary care services expected to result from the Affordable Care Act (ACA) may be felt strongly in rural areas. While studies have found that the quality of care delivered to rural patients is as good or better than that available in urban areas, the belief persists that top-quality primary care is only available in big cities. But a new study appearing in the National Rural Health Association's Journal of Rural Health finds few meaningful differences between rural and urban primary care physicians on key measures of professionalism, including their attitudes about participation in quality care improvement. The study did find differences in the likelihood of physicians' knowing a colleague who was impaired or incompetent, in their confidence evaluating new information and in several aspects of their interactions with patients.

"In terms of professional beliefs and behaviors, we found that rural and urban doctors are more alike than they are different," says study leader Eric G. Campbell, PhD, director of Research at the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) and professor of Medicine at Harvard Medical School. "Despite our results and other evidence, the perception still exists that rural is not as good as that available in cities. So we needed to learn more about the factors driving that misperception and the role it may play in the continuing shortage of rural physicians in the U.S."

Campbell and his co-authors note that, while smaller rural communities may have disadvantages in terms of fewer training options, rural are significantly more likely to participate in activities such as in their practices and hospitals. The fact that rural physicians are more likely to have personal as well as professional relationships with their patients may give them a better sense of environmental and lifestyle factors that affect patients' health but also could lead to challenges when professional responsibilities conflict with patient expectations and perceptions.

This study was designed to determine whether there were significant differences between primary care rural and urban physicians in terms of professional beliefs and in their interest and participation in quality improvement activities. The survey was sent to almost 3,000 practicing physicians randomly selected from an American Medical Association database, almost 2,000 of whom responded. The current report analyzes responses from 840 family practitioners, internists or general pediatricians. Based on ZIP code information, 127 respondents practiced in rural communities, while the other 713 were from urban areas.

There were no significant differences between rural and urban physicians' attitudes regarding participation in quality improvement activities and the importance of open communication with patients, including reporting any errors in their care. Rural physicians were more likely to participate in error-reduction initiatives, in reviews of other physicians' records, and to feel prepared to contribute to quality improvement efforts. They also were more likely to agree that physicians should discuss the costs of care with their patients and to report having added Medicaid or uninsured patients to their patient panels during the preceding year.

"Rural physicians are dedicated to providing high-quality care and committed to supporting safety-net patients," says Anne Kirchhoff, PhD, MPH, corresponding author and an assistant professor of Pediatrics at the University of Utah. "The Affordable Care Act should help more rural primary care providers receive payments for care they currently provide without charge. But as the Medicaid expansion is limited to only half the states, many rural providers will still shoulder a disproportionate cost burden compared with urban physicians."

Although both urban and rural physicians agreed on the importance of reporting colleagues who were incompetent or in some way impaired, rural physicians were significantly more likely to indicate actually knowing about such individuals. Similar percentages of both rural and urban doctors felt prepared to deal with impaired or incompetent colleagues. Rural physicians were more likely to report having fulfilled patient requests for brand-name drugs when less expensive generics were available – a common measure of wasteful medical practice – and were less likely to feel prepared to evaluate new medical information.

"Our findings suggest a deep and broad agreement among primary care physicians on the key tenets of medical professionalism, regardless of the location of their practices," says Campbell. "However we are concerned that, while rural physicians are more likely to know an impaired physician, most of them do not feel prepared to deal with such colleagues. Although rural physicians were more likely to talk to their patients about the costs of their care, they may not be as drug-cost-conscious as they could be. And many don't feel prepared to evaluate new clinical information. We need to further explore the implications of these findings, particular since a significant number of the patients enrolling in new ACA-sponsored health plans will be from ."

Explore further: Rural primary care physicians offer insight into rural women's health care

More information: onlinelibrary.wiley.com/doi/10.1111/jrh.12067/pdf

Related Stories

Rural primary care physicians offer insight into rural women's health care

February 5, 2014
Women living in rural communities are less likely than urban-dwelling women to receive sufficient mental health care, in large part due to limited access to services and societal stigma, according to medicine and public health ...

Amount of care similar for rural, urban medicare users

November 7, 2013
(HealthDay)—Although there may be a limited supply of physicians in some rural areas, little difference is found in the amount of health care received by Medicare beneficiaries for rural versus urban areas within the same ...

AAFP: Telemedicine can help with increased demand for docs

February 17, 2014
(HealthDay)—Telemedicine offers a potential solution to the increased demand for physician-patient interaction, according to a report from a recent forum. The forum was hosted by the Robert Graham Center for Policy Studies ...

Obstetric care may differ at rural versus urban hospitals

December 13, 2013
Rates of unnecessary cesarean section and other potentially risky obstetric procedures show some significant differences between rural and urban hospitals in the United States, reports a study in the January issue of Medical ...

Rural cancer survivors at risk for poor outcomes, study finds

November 28, 2012
Cancer survivors who live in rural areas are more likely to say they are in poor health than those who live in urban areas, according to a study in the journal Cancer. They are also more likely to have other health disorders, ...

Newly insured patients may have trouble finding primary care physicians

November 26, 2012
now assured by the re-election of President Obama – is expected to result in up to 50 million currently uninsured Americans acquiring some type of health insurance coverage. But a study by researchers at the Mongan Institute ...

Recommended for you

Why you should consider more than looks when choosing a fitness tracker

July 25, 2017
A UNSW study of five popular physical activity monitors, including Fitbit and Jawbone models, has found their accuracy differs with the speed of activity, and where they are worn.

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

App lets patients work alone or with others to prevent, monitor, and reverse chronic disease

July 24, 2017
Lack of patient adherence to treatment plans is a lingering, costly problem in the United States. But MIT Media Lab spinout Twine Health is proving that regular interventions from a patient's community of supporters can greatly ...

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.